Medical ethical principles
Research on the importance of medical ethical principles is generally one of three types. The first type, where most of the research has been focused, concerns the moral development and orientation of medical students throughout their medical training [6-9]. However, this body of literature is mainly focused on the developmental nature of morality rather than the specific principles valued, or their role in personal ethical decision making.
The second type of research has examined differences between groups of students with respect to the ethical principles they value [10,11] and compares whether the same principles are important for different professions. These findings have shown that females value autonomy more than males and that medical students are generally more beneficent than lawyers.
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The third kind of research investigates medical students’ evaluations of certain ethical principles [8,12]. The study by Herbert [12] had students read several ethical scenarios and identify as many ethical issues as they could in each scenario. The responses were evaluated post hoc against a “gold standard” marking scheme, where issues were classified as reflecting one of the three principles of autonomy, justice and beneficence. Results indicate that students were able to identify ethical issues in the cases consistent with the principles, however, the responses were often limited in range and tended to be of the same type. Price, Price, Williams and Hoffenberg [8] examined changes in medical students’ attitudes as they progressed through their medical course, where attitudes were defined by the assessment of the ethical principles.
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Westin and Nilstun [13] discuss the principles and whether a certain type of ethical conflict (patient with ischemic heart disease) could be resolved by using “normative” reasoning with the ethical principles. This study was useful in identifying the conflicting nature of the principles for different stakeholders and the difficulties encountered with applying them in practice to a specific case, but it did not take an empirical approach to identifying the importance of the principles and their application. Moreover, it has been criticised for the manner in which the principles were applied or interpreted (principles examined in isolation) in the given case [14].
Landau and Osmo [15] investigated the hierarchies of ethical principles among Israeli social workers. The ethical principle of “Protection of life” was the most important principle guiding the social workers’ decision making with 45% of respondents rating this principle as the most important. However, there was little consensus among the rankings of the ethical principles by the social workers and there was no consistent pattern of application across cases. Professional and personal hierarchies were not significantly different from each other. Social workers responded mainly to the case information and changed the importance of their ethical principles based on the situational information available in each case.
Twelve ethical principles were used in the Landau and Osmo [15] study including “Autonomy & freedom”, “Truthfulness & full disclosure”, “Least harm” and “Public good”. The principles overlap considerably with the four principles but had a more specific social work focus. The 12 principles are also not conceptually distinct. The present study focuses only on six principles with an effort to prevent any conceptual overlap between principles. From a methodological point of view, the Landau and Osmo [15] study was based only on the ranking of principles and simple Likert scales. The present study proposes an additional way to assess the importance of principles by computing the relative weight of principles for each individual. This has the advantage of being able to assess the importance of the principles when two very important principles conflict, which was not the case in the Landau and Osmo [15] study.
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Because of the novelty of this approach and the introduction of a new measure, no specific predictions can very clearly be extrapolated from past findings or empirical research. However, there is considerable theoretical discourse concerning the importance of the principles in medical ethics. Several arguments and pieces of evidence exist that may point to the possible empirical results.
First, the debate on medical principles can indicate which medical principles are the most important. In the Hippocratic Oath the principle of primary importance is Primum non nocere, above all do no harm. This principle has a long history of being very important in health care contexts. The Hippocratic injunction to do no harm has been an axiom central to the education of medical and graduate students [16].
In more recent times, the primary importance of this principle has been contested. In a reflection and discussion of the principles and their merits, Gillon [17] argues for the principle of autonomy to ‘trump the rest’. He provides compelling reasons why respect for autonomy should be of primary importance in medical ethics and applied ethics in general. Different people argue for different hierarchies and yet others argue for no hierarchy at all [18], just the application of all the relevant principles to a case on a more relativistic basis. Prediction from the theoretical literature is therefore not straightforward.
In summary, this study examines the medical ethical principles and uses the AHP as a methodological tool to derive individual weightings for ethical principles. There are two aims of this study. First, to develop and evaluate a measure of the four principles from medical ethics, and second, to determine whether individuals’ rankings of these principles are used in decision-making in ethical scenarios where these principles conflict.
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Category: WHICH
